Purpose: Coronary heart disease (CHD) is a major health problem in Jordan and the
leading cause of death. It is a progressive condition but effective secondary prevention
(SP) that includes behavioural change and medication reduces risk. Little is known
about the current provision of SP for patients with CHD in Jordan. This study was
designed to explore the current provision of SP from perspective of professionals and
to evaluate patients' risk factors, SP interventions received and associated outcomes.
Method: A mixed methods, parallel, repeated measures research design was used
with a purposive sample from three interventional hospitals. A questionnaire was
completed by 16 key staff, 20 Jordanian health care professionals (JHCP) were
interviewed and 180 patients were evaluated in hospital and after 6 months. All
patients had either had an acute myocardial infarction (AMI) treated medically, a
Percutaneous Coronary Intervention (PCI) or a coronary artery bypass graft (CASG).
The quantitative data was collected using self-reported questionnaires and a medical
record review during hospitalisation and six months later. The qualitative data was
collected using semi-structured interviews with JHCP. The European guidelines on
CHD prevention (2012) were used to define recommended targets.
Results: Provision of SP services in Jordan was poor compared to Guideline
recommendations. There was no cardiac rehabilitation, smoking cessation or SP
available post-discharge. Interviews established that while health professionals
expressed the importance of SP, multiple barriers existed. They were generally
dissatisfied with current SP provision and wanted to improve it, but identified training
and other issues that needed to be addressed in order to achieve this. The prevalence
of risk factors in patients was high during hospitalisation and also at follow-up, but
some small improvements at 6 months were observed. Obesity and overweight
reduced from 77% to 75%, smoking reduced from 59% to 47% and physical inactivity
reduced from 59% to 41%. Quality of life was low and anxiety and depression were
high at both baseline and 6 months, but significant improvements over time were
observed. Risk factors such as hypertension and blood sugar control deteriorated over
time and patients' knowledge regarding their condition remained deficient at 6 months.
Conclusion: Despite an extremely high prevalence of risk factors in this population,
the provision of SP is poor and obstacles to its development are widespread. There
was much greater focus on medical treatment arid medication rather than on lifestyle
modifications. Secondary prevention of CHD in Jordan requires urgent improvement
and the potential role of nurses in SP should be enhanced.